Identification of Patients at High Risk for Postsurgical Hypoparathyroidism

Abstract

Background/Aim: Postsurgical hypoparathyroidism (PostHypo) is a common complication after total thyroidectomy. We studied the risk factors associated with PostHypo. Patients and Methods: The study included 109 women, (mean age: 50.7±10.75 years), who underwent total thyroidectomy for thyroid diseases. Results: Based on the development of biochemical hypocalcemia on the first postoperative day following total thyroidectomy, (cCa<8.4 mg/dl), 37 women developed PostHypo and 72 did not. Younger age, a lower preoperative corrected calcium and the presence of parathyroid glands in the specimens were related to the development of PostHypo. Of all patients, 51.4% had a vitamin D deficiency. A parathyroid hormone (PTH) value ≤9.4 pg/ml was 84.9% sensitive and 71.4% specific to predict PostHypo on the 1 st postoperative day. A 50% reduction of the PTH value on the 1 st postoperative day from the preoperative level could identify patients who develop PostHypo with 76% sensitivity and 75% specificity. Conclusion: PTH postoperative measurement and its alteration from the preoperative level can be used to identify patients who are at increased risk to develop PostHypo.

Hypocalcemia as an important differential diagnosis in patients suffering from stridor following thyroidectomy

“…Main postoperative complications of thyroidectomy are injuries to the parathyroid glands and to the laryngeal nerves, but also tracheal compression secondary to hematoma or tracheomalacia. 5,6,9,10 Another possible differential diagnosis of dyspnea is a pulmonary edema due to volume overload, which can be caused by a membranous nephropathy linked to hypothyroidsm. 11 An injury of the parathyroid glands can lead to the manifestation of temporary and even permanent hypocalcemia due to low parathyroid hormone levels.…”

“…11 An injury of the parathyroid glands can lead to the manifestation of temporary and even permanent hypocalcemia due to low parathyroid hormone levels. 10 It occurs in up to 15% of postoperative patients, who can be symptomatic or asymptomatic. 5,10,12 Especially at risk are patients who already present low levels of parathyroid hormone at surgery and in who the parathyroid glands are resected.…”

“…5,10,12 Especially at risk are patients who already present low levels of parathyroid hormone at surgery and in who the parathyroid glands are resected. 10 Hypocalcemia causes an increased neuromuscular irritability that can lead to muscular cramps, circumoral numbness, and paresthesia of the feet and hands-or even to medical emergencies such as laryngospasm, myocardial dysfunction, seizures, generalized or focal tonic muscle cramps in severe cases. 4,5,13 Laryngeal stridor that progresses to laryngospasm can be one of the first signs of hypocalcaemic tetany.…”

“…Especially in postoperative stridor after thyroidectomy, hypocalcemia secondary to hypoparathyroidism is an important differential diagnosis. 6,10 In particular, patients with a re-implantation of a parathyroid gland should be monitored closely and advances in technology can help to predict and prevent patients from a postoperative hypoparathyroidism.…”

Vitamin D Insufficiency Predicts Susceptibility of Parathyroid Hormone Reduction after Total Thyroidectomy in Thyroid Cancer Patients

“…In a meta-analysis of 115 observational studies of bilateral thyroid surgery, age was not significantly associated with postoperative transient hypocalcemia, while female gender and Graves' disease were independent risk factors [ 20 ]. Several studies have suggested that autoimmune thyroiditis and higher cancer stages could be related to a higher risk of postoperative hypoparathyroidism, but there are conflicting reports [ 4 , 9 , 11 , 20 ]. In our study, gender, age, Hashimoto's thyroiditis, tumor size, and N stage were not significantly associated with postoperative hypoparathyroidism.…”